DRUG CALCULATIONS

Considerations for Determining Correct Drug Dosages

Sex Weight Age Physical condition Other drugs that the patient is taking

Persons Responsible for Accurate Dosage Calculations

The

pharmacist who dispenses the drug The prescriber who orders the drug The nurse who administers the drug

Types of Systems Used in Drug Measurement

Metric system Apothecary system Household system Avoirdupois system

Metric System

Most widely used system of measure. Based on the decimal system, All units are determined as multiples of

10. Used worldwide & makes the sharing of

Metric System
Basic

units of measure

For

solid = gram For liquid = liter

Metric System

Solid measure: Gram (g)

1 milligram (mg) = 0.001 g 1 microgram (mcg) = 0.000001 g 1 kilogram (kg) = 1000 g

Liquid measure: Liter (L)

1 milliliter (mL) = 0.001 L 1 mL = 1 cubic centimeter = 1 cc

Apothecary System

Is a very old system of measure that was specifically developed for use by apothecaries or pharmacist. Uses the minim as the basic unit of liquid measure, and the grain as the basic unit of solid measure. Uses Roman numerals placed after the unit of measure to denote amount, for example 15 grains would be written gr xv

Apothecary System
Solid

measure: Grain (gr)

60 gr = 1 dram (dr) 8 dr = 1 ounce (oz)

Liquid

measure: Minim (min)

60 minim = 1 fluidram (f dr) 8 f dr = 1 fluidounce (f oz)

Household System

Pts need to be advised that flatware teaspoons & drinking cups vary tremendously in the volume that they contain. Important to clarify that the measures indicated in the instructions of liquid medication refer to a standardized measuring device.

Household System

Solid measure: Pound (lb)

1

lb = 16 ounces (oz)

Liquid measure: Pint (pt)

2

pt = 1 quart (qt) 4 qt = 1 gallon (gal) 16 oz = 1 pt = 2 cups (c) 32 tablespoons (tbsp) = 1 pt 3 teaspoons (tsp) = 1 tbsp 60 drops (gtt) = 1 tsp

Household System

Measuring system found in recipe books.

Uses the teaspoon as the basic unit of fluid measure and the pound as the basic unit of solid measure.

Avoirdupois System

Uses ounces & grains but they measure differently than those of the apothecary & household systems.
Seldom used by prescriber but may be used for bulk medications that come directly from the manufacturer.

Other Systems

Some drugs are measured in units reflecting the chemical activity or biological equivalence.

One of these measures is the unit (U).

A unit usually reflects the biological activity of the drug in 1 mL of solution. The unit is unique for the drug it measures; a unit of heparin would not be comparable to a unit of insulin.

Milliequivalents (mEq) are used to measure electrolytes (example K, Na,).

Milliequivalent refers to the ionic activity of the drug in question; the order is usually written for a number of milliequivalents instead of a volume of drug.

International units (IU) are sometimes used to measures certain vitamins or enzymes. These are also unique to each drug & cant be converted to another measuring form.

Conversion among Metric, Apothecary & Household System

Metric system Solid measure Apothecary System Household System

1 kg
454 g 1 g= 1000 mg 60 mg 30 mg 15 gr (gr xv) 1 gr (gr i) gr (gr ss)

2.2 lb
1.0 lb

Liquid measure
1 L 1000 mL About 1 qt

Conversion among Metric, Apothecary & Household System

Metric system 240 ml 30 ml Apothecary System 8 f oz ( 8 oz viii) 1 f oz ( f oz i) Household System 1c 2 tbsp

15-16 ml
8 mL 4-5 mL 1 mL 0.06 mL

4 f dr ( f dr iv)
2 f dr ( f dr ii) 1 f dr ( f dr i) 15-16 min ( min xv or min xvi) 1 min (min i)

1 tbps= 3 tsp
2 tsp 1 tsp= 60 gtts

Methods of Calculations
Formula method: D/H x Q = X D - dosage desired or ordered H - what is on hand (available) Q - unit of measure that contains the available dose. When using solid products (tablets, capsules) Q is always 1 and can be eliminated. Q varies when using liquid measures. X - the unknown dosage you need to administer

Example
Order: Potassium Chloride 20 mEq added to the IV. Available: 40 mEq per 10cc. How much potassium will you add? D = 20 mEq H = 40 mEq Q = 10 cc 20 mEq X 10 cc = X 40 mEq 0.5 X 10 = X = 5 cc

Methods of Calculations

Ratio-proportions Ratios indicate a relationship between two numbers with a colon between the numbers. The colon represents division. For example 3:4 = 3/4. Proportions are equations containing ratios of equal value. For example 3:4 = 6:8. This may also be written as fractions, 3/4=6/8.

Ratio-proportions

Means are the two inner numbers, in this case 4 & 6. Extremes are the two outer numbers, 3 and 8. 3:4=6:8 The product of the means (4 X 6) must equal the product of the extremes (3 X 8). Therefore when you do not know one value (x), you can determine it, if the other three values are known.. When setting up a ratio, the known factor (on hand) is stated first, the desired is stated second. H = D x 3:4=x:8 multiply the means and 4x = 3 X 8 the extremes 4x = 24 x= 24 4 = 6

Fractional Formula
3=x 4 8 4x = 3 X 8 = 24 x = 24 4 = 6 cross multiply to obtain the product of the means and extremes

Example
Ordered: 600,000 units of penicillin po q6h Available: 400,000 units per scored tablet How many tablets will you administer? 400,000 units : 1 tablet = 600,000 units : x 600,000 = 400,000x (multiply means 600,000 = x = 1.5 tablets & extremes) 400,000 OR set it up as a fraction 400,000 = 600,000 1 x 400,000x = 600,000 x = 600,000 = 1.5 tablets 400,000

Ratio for Converting Drug Dosages (Tablets)

amount of drug available = amount of drug prescribed one tablet or capsule # of tablets or capsules to give

Ratio for Converting Drug Dosages (Liquids)

amount of drug available = amount of drug prescribed volume available volume to administer

Ratio to Determine Amount of Drops of Fluid to Administer per Minute

drops/minute = mL of solution prescribed per hour x drops delivered per mL 60 minutes/hour

Formula for calculating IV flow rate

V1 X V2 = gtt/min T1 T2

V1 - volume to infuse T1 - time to infuse (hours or minutes) V2 - drop factor T2 - time in minutes - this number is always 60 (minutes/hour) unless you are going to infuse for less than 60 minutes

Medical prescription: 250 ml 5% D/W to infusion over 10 hours. Drip factor is 60. Total fluid = 250 mL(cc) Drip factor = 60 gtts/min Infusion time in minutes = 600 min

Frieds Rule for a Child Younger Than 1 Year

This rule assumes that an adult dose would be appropriate for a child who is 12.5 years (150 months) old

childs dose (age <1 year) = infants age (in months) 150 months x average adult dose

Youngs Rule for Children 1 12 Years Old

childs dose (age 112 years) = childs age in years
childs age in years + 12 x average adult dose

Clarks Rule

Uses the childs weight to calculate the appropriate dose and assumes that the adult dose is based on a 150-lb person

childs dose = weight of child in pounds 150 pounds x average adult dose

Using Childs Surface Area to Determine Dosage

Determine the childs surface area with the use of a nomogram (the height and weight of the child are taken into consideration in this chart)

childs dose = surface area in square meters 1.73 x average adult dose

Sample Nomogram

Basic Drug Calculation Practice Problems

1. Ordered: Trilafon 24 mg po bid. Available: Trilafon concentrate labeled 16 mg/5 ml. How many ml will you administer?

Answer

Ratio-proportions: 24 mg : x = 16 mg : 5 ml 16 x = 24 X 5 = 120 x = 120 16 x = 7.5 ml Formula method: D/H X Q = X 24 X 5 = X 16 1.5 X 5 = 7.5 ml

Basic Drug Calculation Practice Problems

2. Ordered: SoluMedrol 100 mg IM q8h Available: Vial 1 ml in size labeled 125 mg SoluMedrol/3 ml How many ml will you administer? What size syringe is best to administer this dose?

Answer

Ratio-proportion method: 100 mg : x = 125 mg : 3 ml 125 x = 300 x = 300 125 x = 2.4 ml You would need to use a 3 ml syringe. A 5 ml syringe would not give you the decimal point. Formula method: D/H X Q = X 100 125 X 3 ml = x 0.8 X 3 = x 2.4 ml = x

Basic Drug Calculation Practice Problems

3. The physician orders Lasix 20 mg IV stat for a child weighing 34 lbs.

The pediatric handbook states that 1 mg/kg is a safe initial dose. Should you give this dose?

Answer

34 lbs. X 1kg/2.2 lbs = 15.5 kg 15.5 kg X 1 mg/kg = 15.5 mg The does is too high, you need to call the physician.

Basic Drug Calculation Practice Problems

4. Ordered: Infuse 2 L of Lactated Ringers solution in 24 hours. The administration set has 12 gtts/ml. How many gtts/min will you administer the IV?

Answer

2000 ml X 12 gtts/ml = x 24 hr 60 min/hr 24000 = x 1440 16.7 gtts/min or 17 gtts/min = x

Definition of Drug Interaction

The pharmacological result, either desirable or undesirable, of drugs interacting with themselves or with other drugs, with endogenous chemical agents, with components of the diet, or with chemicals used in or resulting from diagnostic tests.